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Physician engagement: A $100,000 per month question – Fall 2014

By Robert Stark, M.D., Consulting Physician, Physician Wellness Services, Minneapolis, Minn., and David Cornett, RPh, Senior Executive Vice President of Business Development, Cejka Search, St. Louis, Mo.

Engagement is a prime driver of physician satisfaction. When physicians feel a lack of engagement—or are outright disengaged—it manifests itself in various ways. For instance, physicians may feel hopelessness, anger, or cynicism and may ultimately want to leave their jobs. This is a matter of particular concern given that turnover and prolonged vacancies are key cost drivers—estimated to run as high as $100,000 per month when all costs and lost revenue are considered.

The term “engagement” is used frequently—but what does it really mean to physicians? Lacking specificity around this—and solid metrics—it’s nearly impossible for healthcare organizations to achieve an increase in engagement with their physician population. The nationwide, multi-specialty survey that Physician Wellness Services conducted with Cejka Search in late 2013 sought to gain a better understanding of what physician engagement really means to physicians and the organizations that employ them. Understanding what engages physicians can assist healthcare organizations in making increased physician engagement actionable.

The 15 Elements of Physician Engagement

  1. Respect for my competency and skills
  2. Feeling that my opinions and ideas are valued
  3. Good relationships with my physician colleagues
  4. Good work/life balance
  5. A voice in how my time is structured and used
  6. Fair compensation for my work
  7. Good relationships with non-physician clinical staff
  8. A broader sense of meaning in my work over and above my day to day duties
  9. A voice in clinical operations and processes
  10. Opportunities to expand my clinical skills and learn new skills
  11. Opportunities for professional development and career advancement
  12. Good relationships with administrators
  13. Alignment with my organization’s mission and goals
  14. Working for an organization that is a leader in innovation and patient care
  15. Participation in setting broader organizational goals and strategies

Note: In rank order of absolute scores to the question: What is important to feeling engaged?

The 1,666 physician respondents confirmed (with a 99% confidence level and +/- 3% margin of error against the national active physician population) that engagement is extremely important to their job satisfaction. Based on a 10-point Likert scale ranging from 1 (unimportant) to 10 (very important), the average score was 8.0, with a quarter scoring 10, and two-thirds (66.2%) scoring it in the high range. Yet, the survey showed their actual feelings of engagement were lower, with average scores of 7.7 for engagement with their work, and just 6.4 for engagement with their organizations.

What does engagement really mean to physicians?
When asked to evaluate 15 elements of engagement, physicians felt that all of the elements of engagement were very important, based upon average survey scores ranging from 7.9 to 9.2 on a 10-point Likert scale. These were well above the 3.0 to 7.0 point mid-range and all in the upper quartile. Moreover, a 10 was the top score by far for all of these elements.

The top five elements of engagement in absolute terms were:

  • Respect for my competency and skills (9.2 average score)
  • Feeling that my opinions and ideas are valued (9.1)
  • Good relationships with my physician colleagues (9.1)
  • Good work/life balance (9.1)
  • A voice in how my time is structured and used (9.0)

The least important elements were participation in setting broader organizational goals and strategies (7.9 average score) and working for a leader in innovation and patient care (8.1), followed by alignment with the organization’s mission and goals (8.2). However, given how high these scores were, it underlines the fact that these elements are still important to physicians—and thus, should not be discounted.

Physician respondents gave universally lower marks for how true they felt these elements were of their current practices, with average scores ranging from 5.8 to 8.0 with a majority in the 6 range. The gaps between what was important to feeling engaged and what was true of their current practices ranged from 0.9 to 2.6 points. The largest gaps were:

  • Feeling that my opinions and ideas are valued (2.6 point gap)
  • A voice in clinical operations and processes (2.4)
  • A voice in how my time is structured and used (2.4)
  • Fair compensation for my work (2.4)
  • Good work/life balance (2.4)

A companion survey of administrators showed they essentially understand the degree to which specific elements are important to physicians’ feelings of engagement, but tend to overstate how well their organizations are providing what physicians want.

Engagement drives career decisions
The cost of overestimating physician satisfaction and not engaging physicians at work may ultimately be reflected in higher physician turnover, lower morale and sub-optimal performance both operationally and clinically. A significant survey takeaway was that administrators often underestimated how large a role engagement plays in a physician’s decision to accept a practice opportunity and/or leave their current job. When asked how important a role engagement plays in physicians’ decisions to accept a practice opportunity, the average score for physicians was 7.3 but only 6.9 for administrators.

The gap in scores was even greater when asked about the role engagement played in physicians’ decisions to leave a practice. Physicians had an average score of 6.3 compared to the average score of 5.4 for administrators. The degree to which administrators underestimate the role engagement plays for a physician making career decisions is troubling given the predicted shortage of physicians as baby boomer physicians retire.

Here are just a few of the many comments physician respondents to the surveys made regarding engagement:

Being engaged, to me, means being part of the team. It means knowing the goals and direction of the organization as well as being a part of the process.

[Engagement is] critical to the success and satisfaction physicians will experience as we go through the changes we will encounter in medicine in the next several years. Those systems whose physicians are fully engaged will succeed at the highest levels.

For many institutions, including mine, engagement is just a concept administrators use to proceed with the difficult, undesirable, but necessary task of working with physicians on running a hospital. They cite it when they want something, ignore it when it will make proceeding more laborious. An administrator who wants you engaged wants something from you, frequently for free.

Many hospital admins seem to think they can demand engagement. In my experience it is a function of mutual respect, good communication and a mission that at its heart supports good patient care. No substitutes exist.

Engagement is about control: control over time, the direction of my career, the number and type of patients I see, the midlevel staff and support staff that I work with. Engagement is a kind of part ownership.

Steps for building engagement initiatives
What can healthcare organizations do to build engagement with their physician population?

  1. Begin by checking the pulse of physicians around engagement. Ask them how engaged they’re currently feeling and what the drivers of engagement are for them. An online survey is ideal, as it’s more likely to get a higher level of participation if responses can be collected anonymously.

    It’s important to dig as deeply into specifics as possible. The goal is to learn about what physicians find most important and where they see gaps compared to what they are currently experiencing.

  2. Sharing the results of the survey in forums that encourage discussion and interaction is critical. Nothing will speak louder about an organization’s commitment to engagement than airing the results and listening to physician reactions. If possible, recruit a physician to serve as a champion or thought leader who can guide the process and encourage participation.

  3. Once there is clear definition around what is important for physicians to feel engaged, develop a roadmap to change, then communicate the strategy and act on it. Make the plan as tangible as possible, and provide tools and resources to support those who are impacted. As tempting as it will be to create a quid pro quo between the elements to focus on and specific organizational goals and initiatives, organizations should resist the urge. Pressing another agenda may be counterproductive and undermine efforts to foster engagement.

Best practices

  • Ensure that physicians are involved in decision making at every step, and if possible, leading key initiatives and activities.
  • Provide training to leaders on how to identify and address barriers effectively—both with physicians and senior administrators.
  • Ensure that there are clear benchmarks and accountability around each initiative— everyone should know who is responsible, time frames, and how progress or success will be measured.
  • Measure progress periodically and adjust tactics, as needed. Communicate results honestly and constructively
  • Organizations with highly disengaged physicians may want to bring in outside, objective parties to facilitate the launch of their engagement initiatives

This survey provides the framework for understanding physicians’ needs to develop the same passion they have for their patients, but this time for their organizations. Engagement is the key to igniting a powerful synergy that will distinguish the great organizations from the merely good ones.

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